Race and discrimination are significant social determinants of health and healthcare access, but nurses can play a key role in tackling the problem. Building trust by working to improve education and access within minority groups is the way forward, says Dr Jasmiry Bennett, Nurse Practitioner Specialist at Yale and Editor-in-Chief of Elsevier’s Journal of Vascular Nursing.
“The best approach to getting the word out in the community is for nurses to actually go into the communities so they can educate, perform screenings, and speak to the people about preventative healthcare,” Dr Bennett said.
The impact of race on healthcare access and outcomes is a complex issue, and while it’s difficult to pinpoint precise causes, it’s clear that there is degree of skepticism among many individuals in minority groups. Much of this appears to be cultural and generational. As Dr Bennett explained:
There are a lot of cultural beliefs with visiting a medical provider. Most prefer to use homeopathic approaches to their ailments. Visiting with a healthcare profession is typically a last resort.
I'm first-generation here in the United States, but for older generations, their thoughts and cultural influences are brought here. Having their own community; they go to their own specific pharmacies that sell certain things that they know from back home and self-treat.
A degree of mistrust of healthcare professionals is relatively common within some communities. Dr Bennett suggests that this suspicion may date back to historical abuse in the medical world, such as the infamous Tuskegee Study. The barbaric experiment, conducted in Alabama between 1932 and 1972, saw hundreds of impoverished African American men deceived into believing that they were being given free government healthcare for syphilis, despite never receiving any.
It’s entirely feasible that the long-term impact of the highly unethical study, along with documented cases of healthcare disparities, have sown the seeds of mistrust. “There's definitely a lot of hesitancy among underrepresented communities to seek medical attention,” said Dr Bennett.
A discrepancy in education among minority communities is also a key issue, she said:
They may not have access to our healthcare system in the way that people who have a full-time job offering benefits may have.
Disparity in healthcare access has been further magnified by the Covid-19 pandemic, with the divide between who can access care and who cannot becoming more evident. Many of those in low-paid jobs may have to go to work in order to get paid, with no access to sick leave or healthcare benefits — a system that perpetuates a negative cycle.
A mistrust of widespread vaccine programs and a hesitancy in vaccine take-up among minority groups is another major issue that has been highlighted in recent months. “There's a lot of skepticism and doubt,” Dr Bennett said. “And there's also a lot of misinformation as well. I think we can do better in reaching out to diverse groups of people.”
Outside of her work, Dr Bennett has personal experience of this reluctance, having seen it first-hand among family members. “It's a challenge to get them to a doctor when they need medical attention because they feel that homoeopathic remedies are probably a better method of treating ailments,” she said. She also describes a “wait and see” mentality in relation to the vaccine, with many people preferring to postpone getting their jab until more is known about any possible effects.
While the pandemic has shone a light on some of these issues, they are far from new, and nurses see the effects every day. As Dr Bennett explained:
People in the minority community often seek medical attention when it’s way too late — when they can no longer deal with the symptoms, and when their homeopathic approaches have not been successful and then they find themselves in crisis. So by the time they come to see a person like myself in a hospital setting, it’s gone beyond prevention and onto crisis, treatment, and emergency stabilization.
So what can nurses do to try and avoid these situations? Dr Bennett highlighted the importance of going out into the community:
One of the things that I’ve done is have health fairs within the poverty-stricken communities to help us identify opportunities early on with preliminary screening and have interventions for people who otherwise would not have gone to a physician or advanced practice provider. Also, it helps for them to see a person like myself who looks like them and who has the education to provide them with the knowledge they need to take care of themselves and to seek medical attention when they need it.
While many community outreach programs are already in place, there is undoubtedly more than can be done if nurses are given more support by healthcare providers in terms of time and resources. Building diversity within leadership is also vital to advocate for these kinds of community outreach initiatives.
Advice on doing community outreach
What advice would Dr Bennett give to other members of the nursing community in holding these outreach events?
What I’ve learned from doing community outreach programs is that in order to be successful, you want to position yourself in an area where you’re going to be visible and capture people’s attention, whether that’s at a grocery store where most of the community shops or at their church.
She also highlights the power of speaking in the community’s native tongue wherever possible:
“When I did a lecture on vascular health in Spanish to a group of Hispanic people, you wouldn’t believe how many questions I had afterwards,” she said. “The knowledge they gained from that one session was just amazing. I gave them my contact information and connected them with physicians in their area; it was fantastic. I think doing more of this, where we speak in their language, would be really helpful.”
While change will take time, advanced practice professionals are well placed to lead from the front lines. Dedicating time to the community to build trust, provide education, and nurture connections with healthcare delivery networks is an essential part of the process. “It's that touchpoint within the community that really we need,” Dr Bennett concluded.
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